January 3, 2008

I've gotten some mail from a few people who are very concerned about a scammy, dangerous diet that is being promoted in the media right now as being "low carb." Without further publicizing the lying weasel profiting from that particular diet, I thought I'd share a few thoughts about how to construct a healthy low carb diet that you can eat, healthily, for years. I learned this stuff through participating for six years in online low carb discussion boards.

1. A low carb diet should not be a high protein diet. Your liver has the ability to transform protein into carbohydrate. Key to losing weight on a low carb diet is that you want to lower the amount of insulin circulating in your body. Eating too much protein may not raise your blood sugar--unless you are a Type 1 or a Type 2 whose beta cells are mostly gone--but it may raise the amount of circulating insulin in your body. Insulin is the hormone that tells your body to store fat, so to lose weight you don't want to eat a high protein diet. You want to eat a diet that contains the right amount of protein.

How much protein do you need? Well, you will need protein to repair damage to your muscles. In addition, if you are eating under 100 grams of carb a day you will probably need some protein to furnish the glucose needed to run your brain. Your liver can turn about 60% of the protein you eat into glucose, so you will eat a bit more protein to provide the glucose for your brain.

Beyond the small amount of protein needed for these two functions, any excess protein you eat can stall your weight loss, and even worse, too much protein in the diet causes the infamous "diet breath" that many people incorrectly label "ketobreath". It isn't ketones you are smelling when people are doing very low carb diets incorrectly. It's byproducts of protein digestion.

How much protein will be right for you depends on how many grams of carbohydrate you are eating and your size. I have put together a web page that tells you How To Calculate Your True Protein Need.

2. A Low Carb Diet Should Be a High Fat Diet.Most of the calories in your low carb diet should be coming from fat. Fat, unlike protein, does NOT raise blood sugar or provoke any insulin response. And now that Gary Taubes has thoroughly debunked the badly conducted, politically motivated research that was used to argue that fat caused heart disease, we can all relax and enjoy the fat we eat.

The exception to the goodness of fats is trans fat. And despite all the labels that claim "no trans fat", any food that lists "hydrogenated" fats of any type on the label does contain trans fat. There are lots of them and you should avoid eating them.

When I was in the active weight loss phase of my year long low carb diet--the one whose 30 lb weight loss I maintained for four years--fat made up about 70% of all the calories I consumed. I'm not a big meat lover, so much of my fat and protein intake came in the form of nuts, eggs, and high quality cheeses.

3. Supplement B Vitamins if You Cut Out GrainsMost of us get our B vitamins, including Folic acid, from grains. So if you stop eating all grains you will have to use a supplement to replace the missing B vitamins. A simple drug store multi-vitamin is all you need. B vitamins are the only vitamins you won't be getting from meat, dairy, and lots of low carb greens, nuts, and berries.

4. Use Morton's Salt Substitute to Replace PotassiumA low carb diet especially in its early phases flushes a lot of fluid out of your body. You can read why this is HERE. The diuretic effect can cause you to lose potassium and if that happens you may get leg cramps.

Sprinkling a bit of Morton's Salt Substitute on your food is all you need to do to correct any potassium imbalance--UNLESS you are taking a potassium sparing blood pressure medicine. In that case, do NOT supplement with potassium. If you aren't sure if your blood pressure medicine is potassium sparing or not, ask a pharmacist. If you are taking a potassium sparing drug you don't have to worry about losing potassium.

If you are low in potassium, the usual symptom is leg cramping which resolves as soon as you consume a sprinkle of the salt substitute which is pure potassium. You can buy it in most supermarkets in the section where the salt is sold.

5. Eat LOTS of Greens and Berries.If you only eat meat and cheese on your "low carb" diet you are going to end up missing valuable nutrients. If you eat meat and greens and packaged "low carb" foods full of chemicals and hidden carbs, you are also going to miss out on those nutrients--and you are going to end up gaining weight, as many packaged foods include ingredients that are forms of MSG (like hydrolyzed vegetable protein) that make you hungry.

In the old days, people in the low carb community used to tell each other "When you visit the supermarket, Shop the edges" . That's because, typically, fruit, veggies, meat, nuts, eggs and dairy are arranged around the outside edge of the market and all the prepared foods are in the aisles. The more you eat from the edges, the healthier you will be. Frozen veggies are fine, too.

6. Use Whey Protein PowderMany low carb recipes tell you to use soy flour. Don't. It tastes nasty to many of us, and soy can have negative effects on your thyroid and can disturb your sex hormone balance. Whey protein powder tastes better than soy and has no hormonal effects. I use it in quite a few of my recipes. Vanilla or plain are best for cooking.

If you find yourself feeling depressive after a few weeks of your low carb diet, cut out any of the soy foods you may have added, including tortillas, "low carb" breads, or cereals. You may be amazed at how much cheerier you feel. I sure was.

7. It is Normal to Feel Edgy The First Week or TwoAs your body switches over to running on ketones you may feel edgy and have trouble sleeping. This is completely normal and it goes away pretty quickly.

7. Take Advantage of Low Carb Beginner's LuckThe first time you eat a very low carb diet, your body has no clue what is going on and may drop surprising amounts of real weight in the month or two before it figures out what the heck is happening.

This is a one time thing. Once your body gets used to living on a low carb ketogenic diet, you will never again experience this burst of dramatic weight loss. You CAN lose weight the second time you go on a low carb diet--I've done it--but it takes a lot longer and requires a lot more discipline.

Because of this "beginner's luck" phenomenon, if you are low carbing for weight loss for the very first time, stick to your diet very carefully for the first three months. Avoid all commercially prepared "low carb" products. Most of them are full of hidden carbs that will sabotage your attempts to lose weight.

Stick with salad, low carb veg, meat, cheese, and small amounts of nuts. Do the diet straight without taking days off as long as you can because by doing that you will get the best weight loss. After a few months when your body gets used to the diet and weight loss drops to a modest amounts you can be a bit more flexible and experiment with different "low carb" products and the occasional higher carb day. But, at first, give yourself a while to let the diet do its magic!

8. Cholesterol Rises Early in Most Effective DietsIf you have a cholesterol test in the first three months of your diet when you are losing weight at a rapid pace expect to see your cholesterol be higher than it was before. This is normal. The fat in your blood stream is on its way OUT of your body. Many doctors don't know this--fortunately, mine did and explained it to me.

By the sixth month of your low carb diet you should start seeing dramatic improvements in your cholesterol, especially your HDL and triglycerides which are the fractions of cholesterol most closely associated with health.

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comments:

I'm so frustrated trying to find a good Dr. Everyone I go to, and pay a lot of money to see each timeI go, never takes the time to discuss anything and in truth really doesn't know any more and in many cases knows less than I do. HELP!!!! I'm so tired of buying expensive prescriptions that don't work only to go back to the Dr. for another prescription that doesn't work.

As someone who lost 180 pounds on the Atkins diet four years ago and have kept it off ever since, THANK YOU for writing this! WOW! Can we get this published in all the major newspapers across America?!

Thank you so much for your informative post. I get so alarmed when I read about starvation plans like Kimkins targeting diabetics, claiming the plan is safe for them because the diet is low in carbs. Yeah, low in carbs and EVERYTHING else! Diabetics practically starving themselves, and being advised to take laxatives every day as well. I agree with your advice, and respect your work a lot.Thanks so much for posting!OYB - Kimorexia Blog

I wish I could get a lot of the stuff I write published. Unfortunately, publishers rarely publish health books unless the author has M.D.after their name or the ability to get on TV as a celebrity.

Beyond that, publishers believe that book buyers are stupid and frightened of big words, so any book I've ever proposed as been rejected as "over the heads" of the supposedly imbecilic health book buyer.

This is why we see a zillion stupid diet books written doctors and TV stars. And why most of them are so bad. Ss old man & his dog quite rightly argues, doctors are clueless about diet. There is no training in nutrition in medical school and doctors get their "diabetes education" from drug company reps and the we-never-saw-a carb-we-didn't-love ADA.

When doctors publish diet books, they often make the "facts" up as they go along and rely on their authority as doctors rather than science to back up their statements.

But wasn't it Barnum who said, "No one ever lost money underestimating the intelligence of the American people?"

I really enjoyed your blog, because it was so straightforward in how to do low carb right!You hit all the important aspects, which make it easy for someone looking for a new WOE.

Thank you for informing those surfing the internet in 2008, that the answers they are looking for are not going to be found at Kimkins.com Any diet that requires one to use very low calories and low fat as the method of weight control is not a safe nor effective way to lose weight.

I'm sorry but I just can't agree that a low carb high fat diet can be healthy or should be followed. A balanced diet is the only healthy diet for the long term. As far as weight loss goes, carbs have nothing to do with it in the long run, it all comes down to calories you can get fat or skinny on a low carb diet. It still comes down to calories. Eat more calories than your body needs and you will gain weight regardless of where those calories come from.

I was interested to read this: "Eating too much protein may not raise your blood sugar--unless you are a Type 1 or a Type 2 whose beta cells are mostly gone". I am a recently diagnosed type 2 diabetic, I am thin and not insulin resistant. I am on a low carb diet because I find it's the best way to control my blood glucose but I notice that when I eat over a certain amount of protein, like two 3 oz pieces of salmon instead of one, my blood glucose is quite high 2 hours post prandial. According to my endocrinologist my diabetes is only "mild" so I wouldn't have thought I had much beta cell damage but I am puzzled. Can you explain why a rise in blood sugar after eating too much protein is an indication of beta cell damage please.

As it digests, protein turns into glucose very slowly. Most Type 2s still produce enough insulin that they are able to cover this tiny infusion of glucose that occurs over 7 hours after eating protein without noticing it.

However, at some point when insulin production fails the glucose produced by digesting protein will not meet some insulin and thus it will raise the blood sugar.

This is why Type 1s are taught to calculate their insulin with protein intake in mind. Type 2s usually can ignore it.

However, about protein requirements, it should be stated that people on calorie restricted or weight loss diet require more protein to maintain lean body mass. The minimum protein need is assuming a diet where insulin levels are sufficient to maintain body mass. If one is doing calorie restriction, whether for health or body fat loss, insulin levels are decreased at this time, so protein is weighted to be more preferentially metabolized for energy (as opposed to driven into tissues as a structural material).

The protein requirements of someone who is losing weight can be much higher than usual. THis is why so many people who lose weight have a "melted" look, like flabby skin over bones. The chronic low insulin state has increased catabolism of all tissues, including muscle mass.

The only way to slow attenuate or reverse this condition is by eating more protein, because protein will increase the insulin and IGF that has so been depleted by lack of carbohydrate.

Yes it will raise insulin, and yes body fat loss may slow, so we must balance good muscle mass against body fat loss. A person with good muscle tone is ahead of the game and can support more of a fat mass than one without as much muscle tone.

Also, meat is pretty high in B vitamins I find; folate is a concern, but eggs are a great source. A few eggs and a serving or two of some kind of dark greens is a good idea. Greens are easy enough for me to eat when I smother them in cream cheese and dressings :) Even reduced fat varieties are great (if one is trying to lose especially quickly, fat reduction will improve glucose clearance thus insulin levels drop more).

Even though my last post mentioned to be wary of artifically low protein calculators (the minimum need to maintain muscle is higher for us than the carb-eating weight-maintaining population, because low insulin tells the metabolism to break down protein rather than store it)...

... but I want to thank you for pointing out protein can and does stall weight loss. If a person is extremely sensitive to insulin overproduction, with profound insulin resistance, they are quite simply going to stall out if they eat a ton of meat. The answer isn't "calories", it's insulin production, in excess, due to high protein intake. Blood sugar appears stable because glycogen is pouring out sugar, but it's also true that the insulin produced from that blood sugar is sending sugar into cells.

... and unless you've got a good insulin receptor situation, you really really want to make sure you avoid this as much as possible.

For people who have pretty good insulin sensitivity, it's not a problem. There are plenty of insulin receptors on muscle cells, so that slightly higher insulin from protein isn't going to stall them out. For a diabetic who has most insulin receptors on fat and few on muscle, and a less total number, the extra weight of protein matters. A lot.

If you follow the link to the page on how to calculate your protein need you will see exactly how much protein a person needs to avoid cannibalizing muscle.

But I think you are wrong about insulin resistance alone causing problems with protein, because the kind of diabetes I have is NOT insulin resistant.

I have dropped my fasting bg 30 mg/dl by using 2 units of Lantus. Two units of fast acting will cover 30-40 grams of protein. A typical type 2 could need 50 units of Lantus and 10-15 of fast acting to do the same thing. But even so, I am still prone to stall eating too much protein.

Plus, eating too much protein results in the horrible bad breath that torpedos so many low carb diets.

A very informative post! I've lost 67 pounds so far on my low-carb diet in just three months. (Actually, I hit three months tomorrow!) I've certainly seen the "beginner's luck" effect you mentioned. I've read some more of your blog after stumbling onto it via Google, and I really appreciate you documenting your personal struggles with diabetes. Thanks!

Great post.Recently Regina blogged about getting sufficient folic acid through low-carb:The current recommendation for folic acid/folate is 400mcg a day. Want to see just how easy it is to meet that intake with real food?

A salad made with 2-cups shredded romaine, 1/4 cup shredded red cabbage, 4 cherry tomatoes and 1/3 of a medium cucumber along with 1-cup cooked spinach provides 437.5mcg of folate before any other folate containing foods are included in the day.

That is what someone following a low carbohydrate diet might choose to eat in a day since it provides just 84-calories, 15g total carbohydrate and 8g of fiber, providng just 7g net carbohydrate in their day. http://weightoftheevidence.blogspot.com/2007/12/real-food-versus-enriched-flour.html

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Stalled on Your Diet?

I was diagnosed with diabetes in 1998. Since then I've kept my A1cs in the 5.0-6.0% range using the techniques you'll find explained at The main Blood Sugar 101 Web Site, where you'll also find extensive discussion of the peer-reviewed research that backs up the statements you read here.

I've also published two books on related subjects, Blood Sugar 101: What They Don't Tell You About Diabetes, which was an Amazon Diabetes bestseller for 3 years and Diet 101: The Truth About Low Carb Diets.